Lumbar Spine - not to miss following points during examination
Contour
paraspinous muscles
Errector Spinae or
Sacrospinalis - Multifidus , Longissimus , Iliocostalis from medial to lateral
Symmetry
Pelvic Obliquity
Step off deformity
Spondylolisthesis - body of involved vertebrae and rest of spine above slide forward
Lateral - Normal lordosis ,
hyperlordosis - flexion contracture of hip
flat back syndrome
compression fracture of lumbar vertebrae
Gibbus - - sharp angular kyphosis kyphotic deformity
TB
Gait - antalgic
heel walk - 10 steps , L4 testing at L 3-4
toe walking
L5 - S1 testing
ROM - flexion 80- 90 , 10 cm to floor
extension 20 - 30 degrees
lateral bending - 20 to 30 degrees
rotation - 30 to 40 degrees
measurement - Schober test
Palpation
spinous process
counting L4-5 , level of iliac crest
paraspinous muscles - tender , tone
posterior facet joints
muscle testing
flexion - rectus abdominis ,
extension - errector spinae
Neurological
sensory
motor
L1 and 2 - Iliopsoas
L 3 - Quadriceps ,
L4 - DF Ankle
L 5- EHL , Gluteus Medius , EDC
S1 - Peronei
Gluetal Maximus
Gastrosoleus
Reflexes - Normal patellar tendon reflexe , L 4
L 5 - TP , Medial Hamstring
S 1 - Achilles Tendon
Nerve Tension
SLR
Lasegue's test - DF after lowering 10 degrees from pain illicited during SLR
Slump - variant of lasegue's test at sitting fom sitting looking straight ahead
allow C and T vertebrae to collapse then bend head
SLR and DF
opposite side
patient tells the experience
thenn extend neck which relieves pain
Bowstring sign - to point of repreoduction of pain , knee flexed
compress nerve on popliteal fossa
sensitivity 0.69 like lasegue's
Femoral Nerve Hyperextension test
Valsalva - Bearing down repoduces pain
Lumbar disc
pain worsens with flexion
as opposed to spondylosis and spondylolisthesis
no step off deformity
paraspinous muscles
Errector Spinae or
Sacrospinalis - Multifidus , Longissimus , Iliocostalis from medial to lateral
Symmetry
Pelvic Obliquity
Step off deformity
Spondylolisthesis - body of involved vertebrae and rest of spine above slide forward
Lateral - Normal lordosis ,
hyperlordosis - flexion contracture of hip
flat back syndrome
compression fracture of lumbar vertebrae
Gibbus - - sharp angular kyphosis kyphotic deformity
TB
Gait - antalgic
heel walk - 10 steps , L4 testing at L 3-4
toe walking
L5 - S1 testing
ROM - flexion 80- 90 , 10 cm to floor
extension 20 - 30 degrees
lateral bending - 20 to 30 degrees
rotation - 30 to 40 degrees
measurement - Schober test
Palpation
spinous process
counting L4-5 , level of iliac crest
paraspinous muscles - tender , tone
posterior facet joints
muscle testing
flexion - rectus abdominis ,
extension - errector spinae
Neurological
sensory
motor
L1 and 2 - Iliopsoas
L 3 - Quadriceps ,
L4 - DF Ankle
L 5- EHL , Gluteus Medius , EDC
S1 - Peronei
Gluetal Maximus
Gastrosoleus
Reflexes - Normal patellar tendon reflexe , L 4
L 5 - TP , Medial Hamstring
S 1 - Achilles Tendon
Nerve Tension
SLR
Lasegue's test - DF after lowering 10 degrees from pain illicited during SLR
Slump - variant of lasegue's test at sitting fom sitting looking straight ahead
allow C and T vertebrae to collapse then bend head
SLR and DF
opposite side
patient tells the experience
thenn extend neck which relieves pain
Bowstring sign - to point of repreoduction of pain , knee flexed
compress nerve on popliteal fossa
sensitivity 0.69 like lasegue's
Femoral Nerve Hyperextension test
Valsalva - Bearing down repoduces pain
Lumbar disc
pain worsens with flexion
as opposed to spondylosis and spondylolisthesis
no step off deformity
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